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Lin YP, Ku CH, Chang CC, Chang ST. Effects of intravascular photobiomodulation on cognitive impairment and crossed cerebellar diaschisis in patients with traumatic brain injury: a longitudinal study. Lasers Med Sci 2023; 38:108. [PMID: 37076743 PMCID: PMC10115718 DOI: 10.1007/s10103-023-03764-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Abstract
The association between intravascular photobiomodulation (iPBM) and crossed cerebellar diaschisis (CCD) and cognitive dysfunction in patients with traumatic brain injury (TBI) remains unknown. We postulate that iPBM might enable greater neurologic improvements. The objective of this study was to evaluate the clinical impact of iPBM on the prognosis of patients with TBI. In this longitudinal study, patients who were diagnosed with TBI were recruited. CCD was identified from brain perfusion images when the uptake difference of both cerebella was > 20%. Thus, two groups were identified: CCD( +) and CCD( -). All patients received general traditional physical therapy and three courses of iPBM (helium-neon laser illuminator, 632.8 nm). Treatment assemblies were conducted on weekdays for 2 consecutive weeks as a solitary treatment course. Three courses of iPBM were performed over 2-3 months, with 1-3 weeks of rest between each course. The outcomes were measured using the Rancho Los Amigos Levels of Cognitive Functioning (LCF) tool. The chi-square test was used to compare categorical variables. Generalized estimating equations were used to verify the associations of various effects between the two groups. p < 0.05 indicated a statistically significant difference. Thirty patients were included and classified into the CCD( +) and CCD( -) groups (n = 15, each group). Statistics showed that before iPBM, CCD in the CCD( +) group was 2.74 (exp 1.0081) times higher than that of CCD( -) group (p = 0.1632). After iPBM, the CCD was 0.64 (exp-0.4436) times lower in the CCD( +) group than in the CCD( -) group (p < 0.0001). Cognitive assessment revealed that, before iPBM, the CCD( +) group had a non-significantly 0.1030 lower LCF score than that of CCD( -) group (p = 0.1632). Similarly, the CCD( +) group had a non-significantly 0.0013 higher score than that of CCD( -) after iPBM treatment (p = 0.7041), indicating no significant differences between the CCD( +) or CCD( -) following iPBM and general physical therapy. CCD was less likely to appear in iPBM-treated patients. Additionally, iPBM was not associated with LCF score. Administration of iPBM could be applied in TBI patients to reduce the occurrence of CCD. The study failed to show differences in cognitive function after iPBM, which still serves as an alternative non-pharmacological intervention.
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Affiliation(s)
- Yen-Po Lin
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Medical Education and Research, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chih-Hung Ku
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Cheng-Chiang Chang
- Department of Physical Medicine and Rehabilitation, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, Neihu District, # 161, Section 6, Minquan East Road, Taipei, 114201, Taiwan
| | - Shin-Tsu Chang
- Department of Physical Medicine and Rehabilitation, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, Neihu District, # 161, Section 6, Minquan East Road, Taipei, 114201, Taiwan.
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Zuoying Dist., # 386, Dazhong 1st Rd., 813414, Kaohsiung, Taiwan.
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Liu CC, Hsu CS, He HC, Cheng YY, Chang ST. Effects of intravascular laser phototherapy on delayed neurological sequelae after carbon monoxide intoxication as evaluated by brain perfusion imaging: A case report and review of the literature. World J Clin Cases 2021; 9:3048-3055. [PMID: 33969090 PMCID: PMC8080739 DOI: 10.12998/wjcc.v9.i13.3048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/21/2020] [Accepted: 12/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Delayed neurological sequelae (DNS) caused by carbon monoxide (CO) intoxication poses considerable treatment challenges for clinical practitioners. In this report, we used nuclear medicine imaging and the Mini-Mental State Examination (MMSE) to evaluate the effectiveness of intravascular laser irradiation of blood (ILIB) therapy for the management of DNS.
CASE SUMMARY A 51-year-old woman presented to our medical center experiencing progressive bradykinesia, rigidity of limbs, gait disturbance, and cognitive impairment. Based on her neurological deficits, laboratory tests and imaging findings, the patient was diagnosed with delayed neurological sequelae of CO intoxication. She received intensive rehabilitation and ILIB therapy during 30 sessions over 2 mo after diagnosis. Brain single-photon emission computed tomography was performed both prior to and after ILIB therapy. The original hypoperfusion area in bilateral striata, bilateral frontal lobe, right parietal lobe, and bilateral cerebellum showed considerable improvement after completion of therapy. The patient’s MMSE score also increased markedly from 6/30 to 25/30. Symptoms of DNS became barely detectable, and the woman was able to carry out her daily living activities independently.
CONCLUSION ILIB therapy could facilitate recovery from delayed neurological sequelae in patients with CO intoxication, as demonstrated by improved cerebral blood flow and functional outcomes in our patient.
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Affiliation(s)
- Chuan-Ching Liu
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Chun-Sheng Hsu
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Rehabilitation Science, Jenteh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan
| | - Hsin-Chen He
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Yuan-Yang Cheng
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Shin-Tsu Chang
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
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Krishnan B, Tousseyn S, Nayak CS, Aung T, Kheder A, Wang ZI, Wu G, Gonzalez-Martinez J, Nair D, Burgess R, Iasemidis L, Najm I, Bulacio J, Alexopoulos AV. Neurovascular networks in epilepsy: Correlating ictal blood perfusion with intracranial electrophysiology. Neuroimage 2021; 231:117838. [PMID: 33577938 DOI: 10.1016/j.neuroimage.2021.117838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/21/2020] [Accepted: 02/01/2021] [Indexed: 11/25/2022] Open
Abstract
Perfusion patterns observed in Subtraction Ictal SPECT Co-registered to MRI (SISCOM) assist in focus localization and surgical planning for patients with medically intractable focal epilepsy. While the localizing value of SISCOM has been widely investigated, its relationship to the underlying electrophysiology has not been extensively studied and is therefore not well understood. In the present study, we set to investigate this relationship in a cohort of 70 consecutive patients who underwent ictal and interictal SPECT studies and subsequent stereo-electroencephalography (SEEG) monitoring for localization of the epileptogenic focus and surgical intervention. Seizures recorded during SEEG evaluation (SEEG seizures) were matched to semiologically-similar seizures during the preoperative ictal SPECT evaluation (SPECT seizures) by comparing the semiological changes in the course of each seizure. The spectral changes of the ictal SEEG with respect to interictal ones over 7 traditional frequency bands (0.1 to 150Hz) were analyzed at each SEEG site. Neurovascular (SEEG/SPECT) relations were assessed by comparing the estimated spectral power density changes of the SEEG at each site with the perfusion changes (SISCOM z-scores) estimated from the acquired SISCOM map at that site. Across patients, a significant correlation (p<0.05) was observed between spectral changes during the SEEG seizure and SISCOM perfusion z-scores. Brain sites with high perfusion z-score exhibited higher increased SEEG power in theta to ripple frequency bands with concurrent suppression in delta and theta frequency bands compared to regions with lower perfusion z-score. The dynamics of the correlation of SISCOM perfusion and SEEG spectral power from ictal onset to seizure end and immediate postictal period were also derived. Forty-six (46) of the 70 patients underwent resective epilepsy surgery. SISCOM z-score and power increase in beta to ripple frequency bands were significantly higher in resected than non-resected sites in the patients who were seizure-free following surgery. This study provides for the first time concrete evidence that both hyper-perfusion and hypo-perfusion patterns observed in SISCOM maps have strong electrophysiological underpinnings, and that integration of the information from SISCOM and SEEG can shed light on the location and dynamics of the underlying epileptic brain networks, and thus advance our anatomo-electro-clinical understanding and approaches to targeted diagnostic and therapeutic interventions.
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Affiliation(s)
- Balu Krishnan
- Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, S51, Cleveland, OH 44195, USA.
| | - Simon Tousseyn
- Academic Center for Epileptology, Kempenhaeghe and Maastricht UMC+, Heeze, The Netherlands
| | - Chetan Sateesh Nayak
- Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, S51, Cleveland, OH 44195, USA
| | - Thandar Aung
- Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, S51, Cleveland, OH 44195, USA
| | - Ammar Kheder
- Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, S51, Cleveland, OH 44195, USA
| | - Z Irene Wang
- Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, S51, Cleveland, OH 44195, USA
| | - Guiyun Wu
- Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, S51, Cleveland, OH 44195, USA
| | - Jorge Gonzalez-Martinez
- Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, S51, Cleveland, OH 44195, USA
| | - Dileep Nair
- Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, S51, Cleveland, OH 44195, USA
| | - Richard Burgess
- Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, S51, Cleveland, OH 44195, USA
| | - Leonidas Iasemidis
- Center for Biomedical Engineering and Rehabilitation Science, Louisiana Tech University, Ruston, LA, USA
| | - Imad Najm
- Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, S51, Cleveland, OH 44195, USA
| | - Juan Bulacio
- Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, S51, Cleveland, OH 44195, USA
| | - Andreas V Alexopoulos
- Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, S51, Cleveland, OH 44195, USA
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Hwang Y, Lee HR, Jo H, Kim D, Joo EY, Seo DW, Hong SB, Shon YM. Regional Ictal Hyperperfusion in the Contralateral Occipital Area May Be a Poor Prognostic Marker of Anterior Temporal Lobectomy: A SISCOM Analysis of MTLE Cases. Neuropsychiatr Dis Treat 2021; 17:2421-2427. [PMID: 34326640 PMCID: PMC8314682 DOI: 10.2147/ndt.s317915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/07/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Subtraction of ictal SPECT coregistered to MRI (SISCOM) provides complementary information for detecting the ictal onset zone, especially in patients with MRI-negative focal epilepsy, and provides additional useful information for predicting long-term postresection outcomes. This study sought to investigate the relationship between surgical failure and increased cerebral blood flow (CBF) pattern using SPECT in patients with mesial temporal lobe epilepsy with unilateral hippocampal sclerosis (MTLE-HS). METHODS Among 42 subjects who underwent anterior temporal lobectomy with amygdalohippocampectomy (ATL-AH) for MTLE-HS, 29 (69.0%) were seizure-free (SF group). Hyperperfusion was compared in 14 ipsilateral and contralateral brain regions in SISCOM images between the two groups. RESULTS The pattern of ictal hyperperfusion in temporal regions did not vary significantly between the SF and non-seizure-free (NSF) groups. However, CBF increases in the contralateral occipital area was more frequent in the NSF group than in the SF group. Furthermore, ictal hyperperfusion of the ipsilateral occipital and contralateral parietal areas tended to be more frequent in the NSF group. CONCLUSION The results indicate that poor ATL-AH surgical outcome is associated with a tendency of ictal hyperperfusion of the contralateral occipital cortex based on SISCOM analysis. The pattern of early ictal CBF changes implicating the propagation from temporal to occipital cortices can be considered a marker of poor surgical outcomes of ATL-AH in MTLE-HS patients.
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Affiliation(s)
- Yoonha Hwang
- Department of Neurology, The Catholic University of Korea Eunpyeong St. Mary's Hospital, Seoul, Republic of Korea
| | - Hwa Reung Lee
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyunjin Jo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Dongyeop Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Eun Yeon Joo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Dae-Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Seung Bong Hong
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Young-Min Shon
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea.,Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences & Technology (SAHIST), Sungkyunkwan University, Seoul, Korea
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5
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A Systematic Review on Tracheostomy in COVID-19 Patients: Current Guidelines and Safety Measures. Indian J Otolaryngol Head Neck Surg 2020; 74:2738-2742. [PMID: 33014752 PMCID: PMC7521770 DOI: 10.1007/s12070-020-02152-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/14/2020] [Indexed: 01/08/2023] Open
Abstract
At this moment the world is fighting with COVID-19 pandemic. Because of increasing number of critical cases, the ICU admissions are also increasing and overwhelming the hospital. These group of patients often required Tracheostomy for proper management and ventilation. As Surgeons we often required to examine and perform procedures in head and neck patients and are in high risk of exposure to aerosol and droplet contamination. We did a literature search for research regarding tracheostomy and its post procedure care during the ongoing COVID-19 pandemic. In this review various international guidelines and sources were put together, and we aim to summarize in a systematic way the available recommendations: indications, timing, technique and safety measures for tracheostomy for COVID-19 patients, from all over the world.
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Copen WA, Lev MH, Rapalino O. Brain perfusion: computed tomography and magnetic resonance techniques. HANDBOOK OF CLINICAL NEUROLOGY 2016; 135:117-135. [PMID: 27432662 DOI: 10.1016/b978-0-444-53485-9.00006-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cerebral perfusion imaging provides assessment of regional microvascular hemodynamics in the living brain, enabling in vivo measurement of a variety of different hemodynamic parameters. Perfusion imaging techniques that are used in the clinical setting usually rely upon X-ray computed tomography (CT) or magnetic resonance imaging (MRI). This chapter reviews CT- and MRI-based perfusion imaging techniques, with attention to image acquisition, clinically relevant aspects of image postprocessing, and fundamental differences between CT- and MRI-based techniques. Correlations with cerebrovascular physiology and potential clinical applications of perfusion imaging are reviewed, focusing upon the two major classes of neurologic disease in which perfusion imaging is most often performed: primary perfusion disorders (including ischemic stroke, transient ischemic attack, and reperfusion syndrome), and brain tumors.
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Affiliation(s)
- William A Copen
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Michael H Lev
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Otto Rapalino
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Monti L, Donati D, Menci E, Cioni S, Bellini M, Grazzini I, Leonini S, Galluzzi P, Severi S, Burroni L, Casasco A, Morbidelli L, Santarnecchi E, Piu P. Cerebral circulation time is prolonged and not correlated with EDSS in multiple sclerosis patients: a study using digital subtracted angiography. PLoS One 2015; 10:e0116681. [PMID: 25679526 PMCID: PMC4334558 DOI: 10.1371/journal.pone.0116681] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 11/13/2014] [Indexed: 12/23/2022] Open
Abstract
Literature has suggested that changes in brain flow circulation occur in patients with multiple sclerosis. In this study, digital subtraction angiography (DSA) was used to measure the absolute CCT value in MS patients and to correlate its value to age at disease onset and duration, and to expand disability status scale (EDSS). DSA assessment was performed on eighty MS patients and on a control group of forty-four age-matched patients. CCT in MS and control groups was calculated by analyzing the angiographic images. Lesion and brain volumes were calculated in a representative group of MS patients. Statistical correlations among CCT and disease duration, age at disease onset, lesion load, brain volumes and EDSS were considered. A significant difference between CCT in MS patients (mean = 4.9s; sd = 1.27s) and control group (mean = 2.8s; sd = 0.51s) was demonstrated. No significant statistical correlation was found between CCT and the other parameters in all MS patients. Significantly increased CCT value in MS patients suggests the presence of microvascular dysfunctions, which do not depend on clinical and MRI findings. Hemodynamic changes may not be exclusively the result of a late chronic inflammatory process.
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Affiliation(s)
- Lucia Monti
- Unit of Neuroimaging and Neurointervention, Department of Neurological and Sensorial Sciences Azienda Ospedaliera Universitaria Senese, Santa Maria alle Scotte General Hospital, Siena, Italy
- * E-mail:
| | - Donatella Donati
- Dept. of Medicine, Surgery & Neuroscience, University of Siena, Siena, Italy
| | - Elisabetta Menci
- Unit of Neuroimaging and Neurointervention, Department of Neurological and Sensorial Sciences Azienda Ospedaliera Universitaria Senese, Santa Maria alle Scotte General Hospital, Siena, Italy
| | - Samuele Cioni
- Unit of Neuroimaging and Neurointervention, Department of Neurological and Sensorial Sciences Azienda Ospedaliera Universitaria Senese, Santa Maria alle Scotte General Hospital, Siena, Italy
| | - Matteo Bellini
- Unit of Neuroimaging and Neurointervention, Department of Neurological and Sensorial Sciences Azienda Ospedaliera Universitaria Senese, Santa Maria alle Scotte General Hospital, Siena, Italy
| | - Irene Grazzini
- Unit of Neuroimaging and Neurointervention, Department of Neurological and Sensorial Sciences Azienda Ospedaliera Universitaria Senese, Santa Maria alle Scotte General Hospital, Siena, Italy
| | - Sara Leonini
- Unit of Neuroimaging and Neurointervention, Department of Neurological and Sensorial Sciences Azienda Ospedaliera Universitaria Senese, Santa Maria alle Scotte General Hospital, Siena, Italy
| | - Paolo Galluzzi
- Unit of Neuroimaging and Neurointervention, Department of Neurological and Sensorial Sciences Azienda Ospedaliera Universitaria Senese, Santa Maria alle Scotte General Hospital, Siena, Italy
| | - Sauro Severi
- Dept. of Neurology, General Hospital of “S. Donato d’Arezzo”, Arezzo, Italy
| | - Luca Burroni
- Unit of Nuclear Medicine, Azienda Ospedaliera Universitaria Senese, Santa Maria alle Scotte General Hospital, Siena, Italy
| | - Alfredo Casasco
- Unit of Endovascular and Percutaneous Therapy, Clinica Nuestra Senora del Rosario, Madrid, Spain
| | | | - Emiliano Santarnecchi
- Dept. of Medicine, Surgery & Neuroscience, University of Siena, Siena, Italy
- Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Pietro Piu
- Dept. of Medicine, Surgery & Neuroscience, University of Siena, Siena, Italy
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9
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Fujitani S, Matsuda K, Nakamura F, Baba K, Usui N, Tottori T, Mihara T, Terada K, Usui K, Inoue Y, Kajita Y, Wakabayashi T. Statistical parametric mapping of interictal 123I-iomazenil SPECT in temporal lobe epilepsy surgery. Epilepsy Res 2013; 106:173-80. [PMID: 23582957 DOI: 10.1016/j.eplepsyres.2013.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 02/04/2013] [Accepted: 03/20/2013] [Indexed: 10/27/2022]
Abstract
Brain single photon emission computed tomography (SPECT) for epilepsy is divided into two types (using three radionuclide tracers)-perfusion SPECT (123I-IMP or 99 mTc-ECD), identifying epileptogenic foci by detecting abnormality in regional cerebral blood flow, and 123I-iomazenil SPECT, identifying epileptogenic foci based on distribution of central benzodiazepine receptors. This study aimed to statistically evaluate and compare the SPECT effectiveness for the three tracers. Statistical parametric mapping (SPM) analysis was performed on 30 mesial temporal lobe epilepsy (mTLE) patients. The radionuclide and patient data were categorized as follows: abnormality in the medial temporal lobe on the operated hemisphere (AAA), in the entire temporal lobe on the operated hemisphere (AA), in the dominantly affected temporal lobe on the operated hemisphere (A), in bilateral temporal lobes (B), with no abnormalities in bilateral temporal lobes (C), and with abnormality in the temporal lobe on the nonoperated hemisphere (D). For analyses of (AAA), (AA), and (A), examining the hemisphere containing epileptogenic foci, IMP-SPECT was significantly superior to ECD-SPECT (P<0.05). For (AAA), indicating localization, IMZ-SPECT was significantly superior to the other two (P<0.05). IMP-SPECT was superior for lateralizing and IMZ-SPECT was useful for localizing epileptogenic foci in mTLE patients though the applicability of the results in extratemporal lobe epilepsy is unknown.
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Affiliation(s)
- Shigeru Fujitani
- Japanese Red Cross Nagoya First Hospital, Michishita-cho 3-35, Nakamura-ku, Nagoya City, Aichi, Japan.
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11
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Goffin K, Dedeurwaerdere S, Van Laere K, Van Paesschen W. Neuronuclear Assessment of Patients With Epilepsy. Semin Nucl Med 2008; 38:227-39. [DOI: 10.1053/j.semnuclmed.2008.02.004] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bartolini A, Gasparetto B, Furlan M, Primavera A, Amore R, Sullo L, Trivelli G. Functional circulation and blood-brain permeability images by Angio CT in the assessment of cerebral ischemia. Comput Med Imaging Graph 1994; 18:151-61. [PMID: 8025881 DOI: 10.1016/0895-6111(94)90024-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We performed rapid sequential computerized tomography (CT) scanning following i.v. injection of a bolus of contrast medium, and generated three functional images related, respectively, to intravascular circulation time (rABCT), vascular volume density (Vv) and blood-brain barrier (BBB) unidirectional constant uptake rate (Ki). This was accomplished by calculating the first mathematical moment of the monitored time-density curves about the injection time, and by the multiple time graph analysis described by Patlack and coworkers. A satisfactory resolution was achieved, allowing separate appreciation of changes in rABCT both at large vessels and at tissue small vessels. Combined evaluation of rABCT and Vv images allowed us to draw qualitative conclusions about blood flow and perfusion reserve.
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Affiliation(s)
- A Bartolini
- Institute of Clinical Neurology, University of Genoa, Italy
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13
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Bartolini A, Gasparetto B, Ajmar G, Amore R, Furlan M. Hemodynamic assessment of vascular malformations by angio CT with generation of functional transit time images. Comput Med Imaging Graph 1992; 16:109-15. [PMID: 1568197 DOI: 10.1016/0895-6111(92)90123-q] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We performed a CT dynamic study during the first pass of an intravenously injected bolus of a iodinated contrast medium, followed by generation of the regional arm-brain circulation time (rABCT) image, in 11 patients with vascular malformations. All lesions could be detected as changes of rABCT, and the comparison with values of normal arteries and veins allowed the deduction of the hemodynamic conditions of the lesions. Seven cases showed evidence of altered distribution of rABCT in the corresponding brain hemisphere, suggesting a perfusion reserve impairment.
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Affiliation(s)
- A Bartolini
- Institute of Clinical Neurology, University of Genoa, Italy
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14
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Bartolini A, Gasparetto B, Albano C, Ajmar G, Amore R, Primavera A, Roncallo F. Functional circulation time images in the diagnosis of cerebral lesions by angio CT. Comput Med Imaging Graph 1991; 15:389-95. [PMID: 1773411 DOI: 10.1016/0895-6111(91)90164-q] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
An application of angio CT as an adjunct to contrast enhancement evaluation of cerebral lesions is presented. We performed rapid sequential scanning following intravenous bolus injection of an iodinated contrast medium, analyzed the time contrast curves and generated a functional circulation time image. This was accomplished by calculating on a pixel-by-pixel basis the first mathematical moment of the monitored time-density curves about injection time which corresponds to regional arm brain circulation time (rABCT). This method increased the rate of detection of cerebral lesions by contrast enhancement from 30 to 90%.
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Affiliation(s)
- A Bartolini
- Institute of Clinical Neurology, University of Genoa, Italy
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15
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Bartolini A, Gasparetto B, Ruffinengo U, Amore R, Primavera A, Albano C. Intravenous 99mTc HM-PAO radionuclide angiography as an adjunct to SPECT assessment of cerebral disease. Comput Med Imaging Graph 1990; 14:91-5. [PMID: 2334889 DOI: 10.1016/s0895-6111(05)80043-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
An application of intravenous radionuclide angiography as an adjunct to SPECT with 99mTc HM-PAO is presented. From the angiographic sequence a two-dimensional parametric image is generated computing, pixel by pixel, the center of gravity (COG) of the local time curves. This index is independent of blood flow and reflects the relation between transmitted and extravasated activity. COG value, compared in two symmetrical regions analyzed for differences in flow by SPECT, may help to state whether a detected SPECT changed uptake is linearly related or not to the corresponding change of blood flow. All 23 ischemic patients taken into consideration had a similar backflux in symmetrical regions with conspicuous changed uptake. In 3 meningiomas and 2 arteriovenous angiomas it was possible to detect the occurrence of a changed backflux in the lesion suggesting a nonlinearity between blood flow and 99mTc HM-PAO uptake.
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Affiliation(s)
- A Bartolini
- Institute of Clinical Neurology, University of Genoa CNR-Center of Cerebral Neurophysiology, Italy
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Bartolini A, Primavera A, Gasparetto B. Evaluation of asymmetries of blood flow rate and of circulation time by intravenous radionuclide cerebral angiography in patients with ischemic completed stroke. ITALIAN JOURNAL OF NEUROLOGICAL SCIENCES 1984; 5:433-6. [PMID: 6099347 DOI: 10.1007/bf02042628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
155 patients with ischemic completed stroke of varying severity and outcome have been evaluated by radionuclide cerebral angiography with analysis of regional time-activity curves. Two parameters have been evaluated: area under the upslope of the curve (Aup) reflecting regional blood flow rate and moment of the whole curve reflecting tracer circulation time (rABCT) Combination of these two methods ensured increased detection of perfusion asymmetries.
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